This action might not be possible to undo. Are you sure you want to continue?
or written language. Augmentative and alternative communication is any method that supplements or replaces speech and writing when these are temporarily or permanently impaired and inadequate to meet all or some of a person's communication needs. Use of AAC involves selecting messages or codes from a set of possibilities. The user can use these elements alone or in combination in order to communicate a variety of messages. AAC may be unaided, or aided, involving high and low technology.
y y y y y y
y y y y y
y y y
1 Unaided AAC 2 Aided AAC o 2.1 Low-tech o 2.2 High-tech 3 Symbols 4 Organization of symbols 5 Access 6 Rate enhancement strategies 7 Team 8 Specific groups of AAC users o 8.1 Cerebral palsy o 8.2 Intellectual impairment o 8.3 Autism o 8.4 Developmental dyspraxia o 8.5 Visual impairment o 8.6 Aphasia o 8.7 Brainstem stroke o 8.8 Amyotrophic lateral sclerosis o 8.9 Parkinson's disease o 8.10 Multiple sclerosis o 8.11 Dementia o 8.12 Traumatic brain injury 9 Effect on speech 10 Multicultural aspects 11 Language and Literacy 12 History of AAC 13 Outcomes o 13.1 Employment o 13.2 Quality of life 14 See also 15 References 16 External links
an example is the Amer-Ind code based on American Indian Hand Talk. and body postures are part of natural communication. More formalized gestural codes exist that lack a base in a naturally occurring language. The benefits of such gestures and pantomime are that they are always available to the user. the user's ability to control gross and fine motor movements needs to be considered with these approaches. and has been used with children with severe-profound disabilities. and adults with a variety of diagnoses including dementia. Since the skills. With signs. In sign systems. Manual signs in particular are less transparent in meaning than gestural codes and require more fine-motor coordination to execute. the communication partners need to understand the signs for successful communication. facial expressions. and are efficient means of communicating. either electronic or non-electronic. manual signs. aphasia and dysarthria. Formal gesture and sign systems require adequate memory and fine-motor skills to be able to remember and physically make the signs and gestures. usually understood by the listener. and such signals may be used by those to profound disabilities. vocalizations. line drawings. As forms of AAC. that is used to transmit or receive messages". Informal vocalizations and gestures such as body movements. areas of difficulty and communication requirements of AAC users vary greatly. such as communication books or voice output devices using symbols such as photographs. such as manually coded language (such as Signing Exact English) and signed languages (such as American Sign Language and British Sign Language) have been used alone or in conjunction with speech.  Aided AAC An AAC aid is any "device.  Low-tech . and signed languages and systems. and include facial expression. the symbols are hand signals which can be iconic (they resemble the word they represent) or more abstract. and so an equally diverse range of communication aids and devices exists to meet these demands. As well. words or letters. as well as for communication partners to understand the symbols made. Unaided AAC Unaided AAC systems are those that do not require any external device for their use. gestures.
These are often very simple aids created by placing letters. such as computers. and thus only a portion of the symbols available are visible at any one time. electricity or electronics to meet the user's communication needs. but which can also be used for other functions.An AAC user uses number coding on an eye gaze communication board Low-tech communication aids are defined as those that do not need batteries.  High-tech High-tech AAC aids are electronic devices that permit the storage and retrieval of messages. all the symbols are constantly displayed on the device. multiple pages of symbols are possible. On static display devices. Since electronic devices operate on batteries that . with the communicator navigating the various pages. a head or mouth stick or light pointer. which have been adapted for use as communication tool. The specific access method will depend on the skills and abilities of the communicator. with most allowing the user to communicate with others using speech output. pictures and/or symbols on a board or in a book. or indirect selection using switches and scanning. High-tech systems can be divided into dedicated devices developed solely for the purpose of communication and AAC. On dynamic AAC devices. words. and non-dedicated devices. High-tech devices vary in size and weight. Such devices can also be referred to as Speech Generating Devices (SGDs) or Voice Output Communication Aids (VOCAs). including the use of direct selection of a screen or keyboard with a body part or pointer. they might indicate yes or no as a listener scans through the possible options. which may be accessed Depending on physical abilities and limitations. Alternatively. They vary in the user can access their messages. phrases. users might indicate the appropriate message with a body part. adapted mice or joysticks. as well as the amount of information they can store and the way it is stored.
and sentences are displayed. . the number of symbols that can be included in a fixed display is limited and in order to compensate the device may be set up on multiple levels. With this system. or an encoding strategy used. whole words. phrases. such as with an alphabet board. On static systems. In an AAC system. determining the size of the graphic symbols or the background-figure contrast). photographs. and visual processing of information when establishing which type of pictures are appropriate for their communication system. in which a person can express multiple messages by combining one to three (or more) symbols on a fixed display. automatically change the selection set on the screen to a new set of symbols. many will use different symbol systems at different times. and may breakdown. This is especially important when the individual has a large number of symbols in an AAC system. while others such as the Picture Communication System (PCS) do not. such as miniature objects representing their real counterpart. such as Blissymbols have linguistic characteristics. In high tech devices such as Voice Output Communication Aids (VOCAs). when activated. words. the communication partner may see the symbols. hand signal. symbols are placed in certain fixed positions. Tangible items can also be part of symbol systems. the device will read the message put together with symbols out loud.  Symbols The representation system or symbols used in AAC include gestures.need to be frequently changed or charged. The user's visual acuity and visual-perceptual discrimination skills will affect the presentation of the symbol system on the AAC device (e. symbols must be organized to facilitate efficient and effective communication. Some users understand the line drawings better than detailed colorful pictures or vice versa. or simple line drawings. words and letters. Both low and high tech devices may use alphabet-based symbols including individual letters. line drawings. It is important to consider the individual user's preference. Picture symbols are used with those who cannot read or write. pictures. In low-tech devices. Symbols can be realistic pictures in color or in black and white. On a "dynamic display". Some picture systems. The choice of symbol system will depend on the AAC user's abilities. Symbols can be strictly visual when located on boards or screen displays or they can be tactile such as with the Picture Exchange Communication System (PECS). Literacy is required for these symbols. visual acuity. the pictures are on cards for the user to move around to form a message. or parts thereof.g. or small items as abstract representations. a computer screen can display linking symbols that. users usually also require access to a low-tech communication system.  Organization of symbols Vocabulary organization refers to the way pictures.
or pictures are combined in a grid format. Symbols can also be presented in a hybrid display. feelings. In grid displays. by grouping people. actions. Research has shown that both children and adults use a small core vocabulary and a large fringe vocabulary. Core vocabulary. including words and messages that are specific to an individual appear on other. These are depictions of events. objects. the words and messages that are communicated most frequently appears on a "main page".e. doing. whereas selecting an individual toy would access the name of the toy. Objects and events within the photograph could then be used as symbols for communication. words. with frequently used phrases and letters clustered along the top or bottom of the display. places. For example. foods. pages. people. as they contain vocabulary that is associated with specific activities or routines.Individual pages of a communication book or device may presented into several ways. or specific experience They are similar to activity displays. objects. feelings. a photo of a child's room could be included in the child's AAC system. photograph. These can include items that are related to an activity (i. phrases. Each display contains symbols for the people. making a list. places. the symbol for "play" could be accessed by selecting the toy box. in which both the grid and visual scene displays appear together. and action words together. The use of these displays has been shown to facilitate language and literacy skills in children. Another form of grid organization groups vocabulary according to specific activities. Research suggests that visual scene displays are easier for young. typically developing children to learn and use. and when. and other relevant vocabulary items for a specific activity or routine. going grocery shopping) or routines within that activity (i. paying for items at the cash register). individual symbols. A user's fringe vocabulary. For example. The grids may be organized in a variety of ways. including by spoken word order or frequency of usage.e. Visual scene displays represent a different method of organizing and presenting symbols. where. or virtual environment representing a situation. Research conducted with typically developing children found that this type of organizational strategy is not useful until they reach at least the age of 6 or 7. what. when compared grid displays. place.  Access . drinks. for example the Fitzgerald Key organization in which symbols are placed from left to right into categories labelled who. Large symbols vocabularies may also be organized by category. and related actions in a picture.
others who cannot do so use alternatives such as mouth sticks. head pointer. whereby items displayed for selection are scanned visually by an indicator (such as small lights. mouse). Although more demanding than circular scanning.e. for example in "timed activation" must maintain contact with the aid for a predetermined period of time for the selection to be recognized by the system. motor. eye gaze. usually due to lack of motor control. it is often introduced first to children or beginning AAC users. With the "release activation". Technological development in direct selection and scanning have dramatically increased access to AAC technologies for individuals with a wide range of communications needs.. head sticks. it is still easy to learn. the individual's physical abilities (e. head nodding) to confirm the choice. the items are displayed in a circle and then scanned them one at a time. One of the most common group-item strategies is row-column scanning in . Direct access is generally the first choice for AAC users as it is cognitively easier and faster to use.g. Whenever AAC users are unable to choose items directly. the AAC user indicates his or her choice by using an alternative selection technique (i. switch access. Finally. In "Linear scanning". switches or eye pointing. As it the easiest to understand. and the device users' and their communication partner's abilities to interact. the least complex pattern.Access using eye gaze on a transparent communication board Access to AAC entails a complex interrelationship between the features of the AAC technology. sensory. or contrasting borders) or auditorily by the communication partner or by the device. items are organized in rows and are scanned one at a time until a choice is made. In this "direct Selection" a selection is made by pointing to the desired symbol using a finger or an alternative pointing technique (i. Several different scanning patterns are available: in "Circular scanning". they use an indirect selection technique called scanning. In order to accommodate motor control difficulties some users use alternative activation strategies. cognitive and linguistic skills). eliminating options until a final selection is made. until the user selects a desired item. this group is then scanned. Some people with severe communication impairments can use their hands to use AAC. perceptual. highlighting. in "group-item scanning" first a group of items is selected. joystick.e. When the desired message is reached. the selection of the item is only made when the person releases contact from the display.
typing "HH" or "G1" (for Greeting 1) may retrieve "Hello. alpha-numeric. There are three main selection control techniques in scanning: in "Automatic scanning". and released to choose the desired item. In iconic encoding strategies such Semantic compaction as sequences of icons (picture symbols) are combined to produce words or phrases. There are two main options for increasing the rate of communication for AAC devices: encoding and prediction. how are you?".which rows of items are first scanned and selected. and the items in the resulting row scanned one at a time until a choice is made. In numeric. the AAC user activates one switch to move the indicator through the items. Word prediction software may determine the choices to be offered based on their frequency in language. AAC evaluations are conducted by specialized multidisciplinary teams consisting of a speechlanguage pathologist. In inverse scanning. and as a result enhance the efficiency of communication. words and sentences are coded as sequences of letters and numbers. Rate enhancement strategies increase the user's rate of output.  Rate enhancement strategies Augmentative and alternative communication is generally slower than speech. social worker and a . sentence or phrase using only one or two activations of their AAC system. word or phrase being written by the user. or grammatical suitability. Encoding is a technique permitting an AAC user to produce an entire word. physiotherapist. the scan proceeds at a pre-determined speed and pattern. the switch is held down to advance the scan. association with other words. Keyboard text-to-speech generating device Prediction is a rate enhancement strategy in which the AAC device attempt to predict the letter. when the desired item or group is reached the individual makes the choice using a control interface such as switch. The user can then select the correct prediction without needing to write the entire word. past choices of the user. and letter encoding (also known as Abbreviation-Expansion). occupational therapist. For example. and another switch to select the item.  Team A comprehensive evaluation of a user's unique abilities and requirements is necessary in order to implement appropriate intervention and match the user with the most appropriate AAC device. In "step scanning".
 During the intervention process. The motor deficits associated with cerebral palsy (CP) cause speech disorders in 31% to 88% of CP patients. Consequently. cognition and vision.physician. The speech-language pathologist's role is to teach the user and their communication partners how to use the AAC device. encouraging the use of natural speech when possible.  Specific groups of AAC users  Cerebral palsy Cerebral palsy is a developmental neuromotor disorder that is the result of a non-progressive abnormality of the developing brain. or adding new information. using complex syntax. This has the potential to lead to delays or failure to develop the full range of communication skills such as initiating or taking the lead in conversation. and may required AAC support for communication. Simple switch-operated speech generating device This population often faces an additional communication challenge. and training of the AAC user about . The team also assesses the user's motor abilities. the occupational therapist assists with the positioning and seating adaptations so that the individual can have the best access to the AAC system. Gross and fine motor challenges may be of particular concern in accessing the AAC device. an individual with spastic arm movements might need a key guard on top of a keyboard or touch screen to minimize the chance of selecting a wrong button. the speech-language pathologist's goal is to ensure that the AAC device can be used in different contexts and with different communication partners. family members. communication skills. For example. The physiotherapist works on motor development training. children with CP may not use their AAC aids as often. Training of communication partners may prevent the development of learned helplessness in children with CP that can result from being passive communicators. caregivers and/or teachers in order to obtain additional information about the user's behaviour and skills in different settings. In selecting and adapting the AAC device for the user's individual needs. in which family members and peers tend to direct and control conversations. making commands. asking questions. The assessment team conducts interviews with the user.
  Intellectual impairment Prior to the mid 1980s. strategies to "manage" behavioural problems included incarceration. school and community environments. medication and aversive behaviour modification techniques. This paradigm shift in the management of behavioural problems for this population has placed new emphasis on AAC because many of these individuals do not have functional speech for communication. AAC interventions in this population are highly individualized. AAC intervention for this population emphasizes partner training as well as opportunities for integrated. making them good candidates for an AAC device. Both notions have been disabused. studies have shown that appropriate use of AAC devices can modify classroom. While most individuals with intellectual disabilities do not have concomitant behavioural problems. . learning strengths and weaknesses. it is known that behavioural problems are typically more prevalent in this population than others.  Autism Autism is a disorder distinguished by qualitative impairments in communication and social interactions and typically have more difficulty acquiring expressive skills. From simple single-switch VOCAs to dynamic displays with visual scenes. to control their environment through communication. They also often lack naturally occurring communication opportunities and responsive communicators with whom they can interact in the home. that result in varying degrees of communication impairments. and even influence the perceptions and stereotypes of communication partners. and using their AAC system to make choices. In the past. make choices. Individuals with intellectual impairments face challenges in developing communication skills. or informing preferences. enhance communication skills. As a result. and developmental patterns for specific types of intellectual disabilities. home. Since the mid 1980s. Children with autism have been found to have strong visual-processing skills. natural communication.how to communicate effectively with others. A great diversity of diagnoses result in intellectual impairments. and social environments for children and adults with intellectual impairments to increase participation. and the use of AAC devices for this population has been substantiated in the research literature. social-relational characteristics. taking control. decisions and mistakes. including problems with generalization (the transfer of learned skills into daily activities). greater emphasis has been placed on teaching functional communication skills to individuals as an alternative to "acting out" for the purpose of exerting independence. taking into account specific abilities of language comprehension. individuals with Intellectual impairment (also known as mental retardation) were often not provided with AAC devices as it was believed that they did not demonstrate prerequisite skills for AAC or because of the notion that AAC would interfere with speech development.
 . and some limited positive impact on social communication and challenging behaviours.  Developmental dyspraxia Developmental dyspraxia is a childhood motor speech disorder involving impairments in the motor control of speech production. as well as facilitating the development of interaction skills. The speech of a child with developmental dyspraxia may be unintelligible to the point that daily communication needs cannot be met and that the child experiences great amounts of frustration. typically causing impairments in motor programming and execution. including providing the child with a concrete means of communication. predict better use of AAC. AAC systems for this population will generally begin with communication boards as well as with object or picture exchanges such as the Picture Exchange Communication System. A 2009 descriptive review provides preliminary evidence that PECS is easily learned by most individuals and provides communication to individuals with little or no functional speech. However. and that it facilitate speech development. as the ease and speed of acquisition of both systems was similar among all participants. and can include signing unintelligible target phonemes (using fingerspelling) alongside speech. Research indicates that AAC use with this clientele does not impede speech development. Manual signs or gestures are the most frequent unaided AAC system introduced to these children. such as joint attention. a study that compared the use of a voice-output communication aid (VOCA) to a picture-exchange system found that each were plausible options for children with autism. A wide variety of AAC systems have been used with children with developmental dyspraxia. Existing functional communication skills. with the hope that speech will improve with time and eventually be able to meet daily communication needs.Speech generating device AAC intervention in this population is directed towards the linguistic and social abilities of the child. AAC can be a strategy to support communication. Manual signs have been shown to decrease articulation and speech sequencing errors. AAC interventions in this population are made alongside more traditional speech therapy to improve natural speech production.
and are thus useful for AAC users who have vision impairments. such that more than one AAC option is introduced to the child.  Visual impairment High and low tech AAC systems require modification in order to make them accessible to AAC users who are blind or who have visual impairments. or both. Some AAC devices that can convert Morse code into text or speech. Tactile/tangible symbols can be used on low or high tech displays and switches. Tactile/tangible symbols are textured objects. This way. While these are portable and tailored to child's communicative needs. and the ability to generate grammatical sentences. Voice output devices provide the user with a much greater vocabulary. Morse Code is an example of an auditory symbol system. Auditory scanning is an access method that utilizes speech with an AAC device. Auditory symbols are those that produce a meaningful sound when activated. Modified visual output that includes large print and/or clear simple graphics can be of benefit to AAC users with some residual vision. the child is not only given the opportunity to experiment with various aided and unaided AAC systems.  Aphasia Aphasia is the result of an impairment to the brain's language centers affecting production. Speech is another example of an auditory symbol that can be integrated with assistive technology for the blind and visually impaired. chronic language impairment.Communication book Aided systems used with children with developmental dyspraxia typically include communication boards or books using graphic symbols. but can also take advantage of certain systems that may be better than others in certain contexts. where long and short tones represent letters. and phrases. words. comprehension. real objects or parts of real objects that may be included on an AAC device for individuals with visual impairment. Braille is further an example of a tactile/tangible reading and writing system. Individuals with . they limit the user's ability to communicate to the topics on the board. and voice output devices. A multimodal approach is often chosen. It presents options to the user by pronouncing them out loud and allows the users to select the desired option upon hearing it. and can cause severe. access to a wider range of topics.
including locked-in syndrome. severe aphasia. drawing. in which photos of events or people that are meaningful to the individual are used to give context to communicative interactions. Eye blinks are frequently used for communication. Static communication device Those with aphasia may use low-tech AAC interventions such as communication and remnant books. and AAC user signals the desired letter is reached. When vertical and horizontal eye movements are functional. which may change over time as needs and skills change. Listener assisted scanning may be used. drawing. and using items such as photographs and maps to help the individual with aphasia produce and comprehend conversation. In addition. a transparent alphabet board may be used. gesture. or other devices. keyboards.aphasia can use AAC to communicate using a variety of means. emotional and linguistic abilities remain intact but all or almost all voluntary motor abilities is lost. Visual scene displays have been used with adults who have chronic. in which the AAC user looks at the desired letter and this is acknowledged . in which cognitive.  Brainstem stroke Strokes that occur in the brainstem may suffer from profound deficits. providing written choices. Approaches such as "Supported Conversation for Adults with Aphasia" train the communication partners to use resources such as writing key words. and written choices. since few recover intelligible speech or functional voice. high-tech AAC devices such as voice output communication aids. Most will need to rely on AAC strategies to communicate. written words and messages. The AAC strategy used varies depending on the time post-stroke. Low-tech alphabet boards are often introduced immediately in order to provide the individual with basic communication. photography. or pictographic grid displays may be used for communication. as vertical and/or horizontal eye movements may be preserved. in which the alphabet is read out by the communication partner. the residual motor capabilities and individual preference. including a combination of speech.
Laser pointers paired with laser-sensing surfaces have been shown to increase the accuracy and consistency of head movements. AAC often becomes the main communicative method. memory. In the later stages of ALS. a head mouse activates the computer. or replacing a regular keyboard with an on-screen keyboard layout activated by a switch or head-mouse. If the patient has good head control. A voluntary. especially in adverse listening conditions (i. . Approximately 75% of people with ALS are unable to speak by the time of their death. Generally. the choice of device has to take into account both present and future needs. Speech generating device accessed using a head mouse The use of high-tech AAC device with individuals with locked-in syndrome may be difficult due to the problems with voluntary muscle activity. wrist or chin.: a noisy restaurant). visual focusing. Examples of assistive hardware and software used with this population include word prediction programs which reduce the effort required to write. AAC may only be necessary to augment natural speech with unfamiliar partners (e.  Amyotrophic lateral sclerosis Amyotrophic Lateral Sclerosis (ALS) or Motor Neurone Disease (MND) is a progressive condition in which the motor neurones required for movement break down.by the communication partner. Since ALS is degenerative in nature. alertness and/or linguistic ability. patience and good memory on the part of the communication partner. speech synthesizer programs which convert written text into speech. although familiar conversation partners may still understand specific spoken words. leading to weakness and eventual paralysis.e. Those who do not have stable head movement require extensive practice to control the AAC device accurately.g. using an alphabet board to cue the listener to the first letter of the word being spoken). though can be the slightest movement of a finger. In most cases. These methods can be very slow and require intense concentration. In the early stages of ALS. AAC is necessary when speech intelligibility becomes inconsistent. reliable and easily controlled muscle movement is necessary to access such as a device. a frowning of the forehead or biting. this happens when speaking rate drops to 100 words per minute.
person with ALS and AAC user The chosen AAC system will depend on severity of speech impairment. These include issues of portability. and cognitive changes including lack of insight into the extent of their communication difficulties. hypokinetic dysarthria may develop later in the disease progression. As a result. Since most individuals with Parkinson's disease are able to communicate using natural speech.Stephen Hawking. and communication needs in particular environments. In the spinal form of ALS. As cognition and vision are unaffected in ALS. the limbs are affected from the onset of the disease. eye gaze and partner assisted scanning are preferred as they carry the added benefit of promoting social closeness. and some individuals eventually lose all functional speech. writing or typing VOCA devices may be optimal. such as eye gazing or partner assisted scanning may be used in situations when electronic devices are unavailable (i. In addition the person may be taught to point to the first . A portable amplifier. functional status. handwriting is often the first course of AAC. durability and powered mobility. physicist. In these cases a high-tech device using a head mouse or eye tracking access may be used.e. AAC devices are generally used to supplement speech. for example. The access to the device depends on the type and severity of the disease. As the disease progresses and starts affecting hand movement.  Parkinson's disease Parkinson's disease is a progressive neurological condition in which initially no speech disorder may be present.: during bathing). In the final stages of the disease. speech is affected before the limbs. In the bulbar form of ALS. However. Low-tech systems. increases the volume of a person's voice and thus intelligibility. as these require less manual dexterity. while still offering full freedom of expression. Factors affecting AAC use in Parkinson's disease include the motor deficits. writing and typing systems tend to be the most recommended and preferred devices because they allow unlimited expression.
 Low tech devices. judgment or executive functions. The use of augmented listening strategies. AAC intervention for individuals with dementia is relatively new. Depending on the stage of recovery. AAC is also used to enhance the comprehension of those with dementia.  Multiple sclerosis Dysarthria is the most common communication problem in individuals with multiple sclerosis (MS). more longer term AAC. Its most common form is Alzheimer's disease. and several studies have shown positive outcomes in the amount of on-topic conversation and the length of interaction with their use. such as identifying topics of conversation with pictures improves the conversational skills of individuals with dementia. Since Parkinson's disease is associated with reduced range and speed of movement. such as language. training designed to teach individuals with dementia to use such memory aids.  Traumatic brain injury Traumatic brain injury (TBI) results in severe motor speech disorders²particularly dysarthria. Entire words can be spelled out if necessary. Individuals with MS vary widely in their motor control capacity and the presence of intention tremor. the facilitation of reliable yes/no responses and the ability to express basic needs and to answer questions. Communication impairments are partly attributed to memory deficits. Memory impairments and difficulties with new learning may influence AAC .letter of each word on an alphabet board supplementation. focussing on recognition rather than recall. this results in a reduced speech rate and visual information for the listener to compensate for impaired articulation. and later. Individuals who do not recover natural speech to a degree sufficient to meet their communication needs typically suffer from severe impairments related to cognition. High-tech devices with voice output have been found to be less effective: in one study such devices resulted in limited topic elaboration/initiation. such as memory books. including autobiographical information and daily schedules. was found to be maintained four months after intervention. High-tech AAC keyboard speechgenerating devices are also used. chronic. keyguards may be required to prevent accidental keystrokes caused by tremor. Its goal is to compensate for deficits and to capitalize on the person's strengths. and communication cards acting as reminders or labels are generally preferred. visuospatial function. significant difficulties with speech and intelligibility are uncommon. in roughly a third of cases. and 35% of people with MS experience optic neuritis as the first symptom. Visual impairments are common in MS. or synthetic speech feedback that plays back words and letters as they are typed.  Dementia Dementia is an acquired. cognitive impairment characterized by deficits in memory and in at least one additional cognitive domain. AAC users with visual impairments may require devices that allow auditory scanning systems. a small-sized board may be preferred. if necessary. In addition. and methods of access to AAC technology are adapted accordingly. including high-tech systems. small wallets with photographs. AAC intervention may involve the establishment of consistent responses. large-print text. reduced output and heightened distraction. apraxia (movement).
 Problems with initiation and generalization of new skills may influence the extent to which the AAC system is used in daily life. Some cultures do not want the AAC to attract attention to the user. and may result in increased speech production. with modest gains observed. Respecting ethnicity and family beliefs are key to a family-centered and ethnically competent approach. A 2009 descriptive review that looked specifically at PECS intervention studies. As a result. Culturally diverse child rearing practices influence AAC intervention. allowing the individual to focus on communication. and that the reduction in psychological stress making speech production easier. politeness. Accepting a communication aid and being labeled with a disability may be easier for some cultures which promote accessibility. but they require consideration to promote cultural respect. often during later phases. a model of spoken output is provided which may lead to an increase in speech production. respect and understanding of cultural diversity can help prevent family alienation. thus the training and involvement of communication partners is generally necessary. overlearned techniques such as spelling may be more effective than AAC systems which require navigation through multiple pages to access information.choices.From the team's perspective. and respect toward authority figures. These priorities may differ considerably from the AAC team's views. Other cultures may place greater value on hierarchical family structures. Ethnic awareness helps professionals determine which AAC system is best suited for their client. and culturally specific views about disabilities in general. Others speculate that. Providing AAC services requires the input of family. since individuals with TBI may have difficulty recalling where information has been stored. and natural interventions may be . the need for an AAC is a private matter and they will not want to attend training sessions. Disability may also be viewed with a stigma. indirect communication. folk. Professionals must consider the "visibility" of the device. a 2008 systematic review found that AAC use does not impede the development of speech. and found inconsistent and unclear data on whether PECS led to increased speech.  Effect on speech In contrast to fears expressed by family members and clinicians. in the case of speech generating devices. while one noted little or no effect. Researchers hypothesize that using an AAC device relieves the pressure of having to speak. particularly for early intervention. AAC service providers may face challenges due to their lack of information about other cultures. due to families' attitudes about their own involvement in their child's care or their loved one. contribute to the selection of the right AAC system for the user.  Multicultural aspects Cross cultural differences should be taken into account when assessing and planning for AAC intervention. spiritual. several studies reported an increase in speech. thus. and to the family wanting to continue collaborating with the AAC team.
school. including the need for the communication device to help promote self-determination. the ability to make one's own decisions and choices about one's life. literacy fosters independence by providing access to educational and vocational opportunities. Cultural sensitivity may require avoiding stereotyping color and symbols. Literate AAC users often report having access to abundant reading and writing material at home as well as in school during childhood. since these children may fall behind their typically developing peers in regular classrooms that assume a certain level of language mastery. current research suggests that with explicit reading instruction. an AAC device may not be considered necessary if the goal is to increase the user's independence and promote individualism. as well as the deaf community's pursuit of the . also leads to weaker knowledge about the world and vocabulary. and social settings. Language and literacy delay have far reaching effects as they facilitate self-expression and social interaction in face-to-face conversation and provide opportunities to participate in home. Some cultural groups consider a child's independence as a rebellion. work. reduced expectations of teachers and parents mean that AAC users are often given fewer opportunities to engage in reading and writing activities in and outside of the classroom. Engaging in rich language and literacy experiences before entering school fosters vocabulary development. At this time. professionals consider several factors. During the 1960s in the United States. length of sentences. Other cultures may expect an AAC device will immediately reduce the visibility of the disability. The limited experience/exposure to print. Most children who use AAC do not achieve literacy skills beyond a second grade level. its modern inception began in the 1950s. and phonological awareness. These cognitive.. the Civil Rights Movement. language and learning delays contribute to difficulty with literacy development. and impaired pragmatic skills. i. and quality of experience. such as using black to denote "wrong" or "bad" and using culturally specific symbols and colors. range. and do not believe children should be allowed to have greater control of their own lives.  Language and Literacy Children who use AAC often experience developmental delays in vocabulary knowledge. discourse skills. which limits the amount of time. When attempting to match the AAC system to the user. AAC users can better develop good literacy skills.preferred over modern technology. AAC devices were mainly implemented for those whose oral and laryngeal anatomy was damaged by surgical procedures such as laryngectomies and glossectomies.e. with the first use of augmentative strategies with the deaf. Thus. while other cultures may prefer not to have an AAC device at all in order to reduce stigma. all of which supports successful literacy learning. Many of those whose disabilities require AAC have difficulties learning to read and write due to a variety of impairments that can affect emergent literacy. Furthermore.  History of AAC Although AAC can trace its roots back to the early days of Ancient Rome. In addition. However. syntax.
in most cases AAC strategies were only employed after traditional speech therapy had failed. helped increase public and governmental awareness of the issues related to AAC. According to U. cerebral palsy and amyotrophic lateral sclerosis. Since the 1990s. legislation began requiring that all children received educational services. stated that all individuals with severe communication disabilities have a right to use AAC devices at all times as well as a right to information and the opportunity to have and make choices. The American Speech-Language-Hearing Association published a position paper regarding AAC as a field of practice for speech-language pathologists in 1981. compelling classroom teachers to find ways in which to assist communicative exchanges. as many felt hesitant to provide non-speech intervention to those who might be able to learn to communicate verbally. it is possible for AAC users to achieve success in educational endeavors and employment. During the late 1960s. In 1992. Individuals with a severe disability such as ALS using AAC may continue working. many children with disabilities entered the school system. Personality factors that have been found to be related to employment are a strong work ethic and access to . During the beginning of the 1980s. However. newsletters. Access to AAC. AAC devices were also used with individuals where intelligible speech would likely never be possible. As a result. and textbooks on the matter were published as well as the first international conferences.S. some AAC users also maintain higher-skilled jobs. less than 10% were employed. which has led professionals to seek ways for children with disabilities to participate more comprehensively and successfully in classroom activities.  Outcomes  Employment Physical disability may reduce the ability to work and individuals with severe physical disabilities are often forced to discontinue their employment. Articles. there has been an increase in in-class and natural education techniques. and in 1983. as opposed to traditional pull-out methods. This view continued to dominate the field until the 1970s. determination and a positive attitude helped the individuals in this study to participate in society and have a good quality of life. manual sign languages were used with individuals who had both hearing and cognitive impairments. Despite the various barriers to employment. the International Society for Alternative and Augmentative Communication (ISAAC) was founded. Better work experiences were related to a positive and supportive work environment.right to be educated using American Sign Language (ASL). This inclusion model promotes the enrichment of functional skills taught within a natural context. the Communication Bill of Rights. among severely disabled individuals. Census Bureau (1997). AAC became an area of professional specialization. set forth by the National Joint Committee for the Communication Needs of Persons with Severe Disabilities. including those with severe dysarthrias. Although they are frequently limited to low wage jobs.
  Quality of life AAC users generally have satisfying relationships with family and friends. and dissatisfaction with communication devices that exist for AAC users. remaining optimistic even when unemployed. which results in communication barriers for AAC users. There may. The negative outcomes are related to dissatisfaction with the service delivery and AAC supports. These issues reflect issues with policy barriers. especially when postsecondary education or employment are not pursued. Family and friend support. and engage in pleasurable and interesting life activities. however be more negative post-school quality of life outcomes. . lack of resources.AAC technology. education and work skills are also related to positive employment outcomes.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.